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Epilepsy

Steve Smith discusses epilepsy
© University of East Anglia

Epilepsy is characterised by repeated events known as ‘seizures’ in which there are sudden bursts of synchronised electrical activity within the brain leading to altered consciousness, involuntary movements and sensations. Epilepsy is most often diagnosed in children or adults over 65 but can affect people of all ages. It is relatively common – about 1 in 100 people are affected.

Experiencing a seizure does not equate with having epilepsy; insufficient sleep, or highly emotional experiences, even subconscious memories past events can trigger a seizure. Epilepsy is diagnosed in someone who experiences two ‘unprovoked’ seizures – that is, one that cannot be explained by a reversible factor such as alcohol withdrawal or hypoglycaemia (very low blood sugar as can occur in diabetes).

In March 2017 the International League Against Epilepsy, (ILAE) introduced updated guidance on describing seizures- sharing similar language across the world helps professionals collaborate with regard to treatment and research. Seizures are grouped according to:

  • the location of onset in the brain; if confined to a small brain area they are called ‘focal’ seizures; if the activity is widely distributed across the brain, they are called ‘generalised’ seizures. ‘Unknown onset’ seizures are a further category.
  • whether conscious awareness is affected.
  • Whether there are other symptoms such as involuntary movements.

In a ‘tonic clonic’ seizure the person becomes unconscious, the body stiffens and if standing will fall, usually backwards. Limbs jerk and shake – the bladder may void. Normally after several minutes breathing returns to normal, the person may feel disorientated and tired, and may need a rest. In a focal seizure involving movement effects, typically one limb my be jerking, the person may or may not be aware. Motor symptoms of focal seizures may include unusual mouth movements, picking at objects or clothes, one or more limbs jerking or becoming floppy or stiff. Non-motor symptoms might include a strange taste; a sense of elation or of fear; twitching, numbness or ‘pins and needles’ (parasthesias) or visual disturbances.

Some seizures, called ‘absence’ seizures are typically less dramatic, and occur most often in children. The person seems to go into a daydream – loses conscious awareness usually for a short period

How to respond if someone near you has a seizure:

  • Keep calm and make the environment safe.
  • If the person is safe, don’t move them. Note the time of the onset of the seizure. Stay with them.
  • Protect the head- perhaps with a cushion if they’re on a hard surface.
  • When they recover check the time again.

Gently move the person into a recovery position (check how to do this easy procedure in any good first aid book). Look to check for a clear airway – nothing blocking the mouth such as dislodged false teeth or food. Don’t put your fingers into the mouth to check, only remove anything obviously blocking and easy to grasp. If breathing seems laboured after the seizure call an ambulance (999 in the UK, 911 in the USA). If the seizure hasn’t stopped after 5 minutes, call an ambulance. If this is the person’s first seizure, call an ambulance. If one seizure follows another without recovery in between, call an ambulance.

© University of East Anglia
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